Kenneth Allen Mitchell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA970 Issued in AR

Practice address

6025 Lake Rd
Suite 200
Woodbury, MN 55125-1712

Phone

(651) 999-6800

Fax

(651) 999-6830

NPI assigned

Oct 10, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.mitchell@1053726469783556.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chattanooga Hamilton County Hospital Authority

  • Internal Medicine Physician
  • Chattanooga, TN
  • NPI 1154751931
  Medicare reassignment NPD
• Erlanger Health

  • Internal Medicine Physician
  • Chattanooga, TN
  • NPI 1477256303
  Medicare reassignment NPD
• Pazona MD, PLLC

  • Urology Physician
  • Nashville, TN
  • NPI 1508481284
  Medicare reassignment
• Chattanooga Hamilton County Hospital Authority

  • Medicare Defined Swing Bed Hospital Unit
  • Pikeville, TN
  • NPI 1073622007
  NPD
• Erlanger Health

  • Durable Medical Equipment & Medical Supplies
  • Chattanooga, TN
  • NPI 1740073329
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1922096379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 CENTERVIEW DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114349",
            "telephone_number": "501-219-8900",
            "fax_number": "501-410-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 LAKE RD",
            "address_2": "SUITE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251712",
            "telephone_number": "651-999-6800",
            "fax_number": "651-999-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KENNETH",
        "middle_name": "ALLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA970",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "534141800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Minnetonka Imaging MRI, Inc.
• Minnhealth Family Physicians, P.a.
• Shahla Mirbaghri
• Jacquelyn Faith Mirr, MD
• Mackenzie Ann Mirsch
• Lara Elisabeth Mitchell
• Hafsa Nur Moalin
• Fadiila Mohamed
• Khadro Adan Mohamed
• Ismael Isac Mohammed

• Physician Assistant in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.